by Amy Moore
Almost no one wants to live any place other than his or her own home. Even though you as a caregiver may be committed to caring for your relative at home, situations may arise that make placement in a facility a necessity, not a choice. You may become ill and need to find another place for your relative to live until your condition allows you to resume your caregiving responsibilities. Or your relative’s condition may progress to a point where you can no longer provide the level of care that is needed. If either of these situations occurs you will find yourself in the position of needing to evaluate and choose a new housing arrangement for your relative.
It is impossible to choose a facility without first determining the type of care your relative needs. Not only will that information help you in finding a home that provides the appropriate level of care for your relative, it will also be a major factor in determining what, if any, government aid (Medicare or Medicaid) your loved one is eligible for. Medicare covers skilled nursing and rehabilitative care, but generally doesn’t cover custodial care (help with activities of daily living) if that is the only care needed. Medicaid is a joint Federal and State program that helps with medical costs for some people with low incomes and limited resources. Consider whether your relative needs help with activities of daily living which include bathing, dressing, eating, going to the toilet, mobility, and getting in and out of bed or a chair. Also consider instrumental activities of daily living which include cooking, cleaning, shopping, taking medications, and paying bills. An overall picture of your relative’s needs and abilities can help you in choosing the best level of care. In Washington there are five types of institutional facilities available to adults needing care: 1
Adult Family Homes are residential homes licensed to care for up to six residents. They provide room, board, laundry, necessary supervision, assistance with activities of daily living, personal care, and social services.
Assisted Living offers private apartments. This type of housing provides privacy, independence and personal choice. Services include meals, personal care, medication assistance, limited supervision, organized activities and limited nursing services. Staff is available around the clock.
Adult Residential Care facilities are licensed boarding homes. Room and board, help with medications and personal care are available. Residents may have limited supervision.
Enhanced Adult Residential Care provides all the same services as Adult Residential Care and in addition, limited nursing care can be provided. No more than two people share a room.
Nursing Home Care provides 24-hour supervised nursing care, personal care, therapy, supervised nutrition, organized activities, social services, room, board and laundry.
Once you have determined the best level of care for your relative, check out a number of facilities that meet your geographic and financial requirements. You will want to visit and ask questions before making a final decision about moving to a new housing arrangement. As you tour facilities, note these considerations:
Safety: Are there sufficient smoke detectors, emergency exits, wheelchair ramps, call buttons, handrails in bathroom and bedrooms?
Livability: Do the residents look clean and cared for? Are they engaged in various activities, or are they simply sitting and staring? Are there opportunities to sit or spend time outdoors? Are physical restraints used excessively? Are the common rooms clean and welcoming? Are there any overwhelming and unpleasant odors?
Room Comfort: Are the bedrooms big enough, with space for residents’ belongings? Can the residents decorate their own rooms? Is there adequate privacy?
Staff: Are there enough staff? Does the staff treat residents respectfully and kindly? Does the staff radiate a generally pleasant and cheerful demeanor?
Nutrition: Is the food nutritious and appealing? Are fresh fruits and vegetables served? Are snacks available? Is the menu varied and are special diets available? Do the current residents say they like the food?
Scheduling: Is there flexibility in sleeping and eating schedules? Are there varied activities available throughout the day?
Care Planning: Does the staff develop individualized plans of care for each resident? Are family caregivers involved in decision making and evaluations of the resident?
Limitations: What types of behaviors or medical problems can the facility not deal with? Are they able to accommodate individuals who wander or have more disruptive behaviors? Can they provide assistance with eating and walking when it is needed? What would trigger a discharge or transfer from the residence?
It is difficult to move your relative from his or her home to a facility. It can be beneficial for both of you to do some of the research ahead of time, when you are not feeling stressed about making a quick decision. This can increase your chances of finding the best living situation for your relative.
An invaluable “Guide to Choosing a Nursing Home” can be viewed on the web at www.medicare.gov. Select “Find a Medicare Publication.” Or you can order the guide from Medicare by calling 1-800-MEDICARE (1-800-633-4227).
1 The Washington State Department of Social and Health Services provides assistance in locating facilities in your community through their website: http://www.aasa.dshs.wa.gov/topics/rescare.htm